Preschool Development & Family Guide PDF

N7410 Final Study Guide Preschoolers, School Age, Adolescence, Individual & Family Risks/Strengths/Resiliency, Transition to Adulthood Module 8: Preschool Age Development Lecture: - “Magic Years” since pre-k kids are playful, helpful, energetic, unus...

N7410 Final Study Guide Preschoolers, School Age, Adolescence, Individual & Family Risks/Strengths/Resiliency, Transition to Adulthood Module 8: Preschool Age Development Lecture: - “Magic Years” since pre-k kids are playful, helpful, energetic, unusually generous, likes to please, curious - Usually an easier time for parents - Decreasing growth velocity for height and weight - Height ~7.6 cm per year - Weight ~2-3 kg per year - Body shape becomes leaner, more upright, less pot belly - Head size decreases in proportion to the rest of the body - Slowing brain growth - Live to play! - Need practice with skills in gross motor play within safe spaces - Fine motor skills developed in good pre-k settings, like Montessori activities - Use scissors, beads, can openers, drawing, sorting, bread, clay - Art used for fun and assessment - Cephalopods - Draw a person/family during visit and have them tell you about it - Sociodramatic play allows kids to express range of emotions, practice skills, develop muscles - Cultural differences: Legos to make gun vs PB&J sandwich - Imaginary Friends from 2.5 to 4.5 years old - Superego Auxiliary = imaginary friend tells them not to pull cat’s tail - Scapegoat if in trouble - Prolong feelings of control = I tell imaginary friend to go to bed! - Defiance/provocation = Imaginary friend doesn’t like the food you made - Mediation of loneliness = Imaginary friend loves me more than anyone - NICHD 2006 Study : - High Quality childcare leads to better language and cognitive development at 4.5 years, more cooperation - Higher quantity childcares associated with more behavior issues - Child care centers improve cognition and language, but worse behavior than at home/having family caregivers  - OVERALL FAMILY CHARACTERISTICS MORE POWERFUL CHILD DEVELOPMENT THAN CHILD CARE CENTERS - Bullying in preschool: - AMAB 4.5x more likely to be expelled from prek - More 4 yo expelled than 3 yo - Rates double for school expulsion if no access to mental health consultants - Lower rate of expulsion in prek if in public schools and head start program - Higher rate of expulsion in faith-based or for-profit centers 3 Years Old: - Gross Motor at 3 yo: - 1 second stand on 1 foot - 3 hops - Walk upstairs alternating feet - bounces/throws ball overhand - Climbs high - Pedals tricycle - Fine Motor at 3 yo: - Bilateral handedness 🔴 - 9-10 block tower - Copies circle - Piaget at 3 yo: Preoperational, and lives only in the present - Language at 3 yo: - 1000 words - 3-4 word sentences - 75% of words are intelligible - Start plurals, pronouns, asking questions - Common disfluencies of speech - Identity at 3 yo: Knows own gender, own skin color - Play at 3 yo = parallel or associative play 4 Years Old: - Gross Motor at 4 yo: - Smooth running - 5 seconds stand on 1 foot - Tandem walking - 5 hops - Fine Motor at 4 yo: - Pours without spilling  - Favors one hand - Cuts straight line - Draws 3-parts recognizable human figure - Piaget at 4 yo: Preoperation, but starts to understand past tense - Language at 4 yo: - 50 words/month - 4-5 word sentences - Fully intelligible speech - Past tense - Only some disfluencies - Identity at 4 yo: gender roles and characteristics understood, aware of different skin and hair colors, starts to identify self as part of racial/ethnic group - Play at 4 yo: Cooperative play 5 Years Old: - Gross Motor at 5 yo: - 10 seconds stand on 1 foot - Skips - Catches bounced balls - 10 hops 🟨 - Fine Motor at 5 yo: - Copies square - Draws 6-part human - Dominant hand and foot by 6 or 7 - Piaget at 5 yo: Preoperational, begins to understand future - Language at 5 yo: - 50 words/month - 8-10 word sentences - Stories - Paragraphs - Future tense - No disfluencies expected - Identity at 5 yo: aware of different skin/hair colors, identify as part of group - After 5, ethnic awareness depends on experiences with majority culture or racism - Cooperative play still after 4 years Piaget Preschool - Preoperational - Continuously organizing and reorganizing experiences - Assimilation: taking in new information in pre-k lessons  - Accommodation: making changes based on trial and error, like with puzzles - Prelogical Cognitive Development - Semiotic language = Use symbols and representative language, like spoken or written signs - Shoe box is a make believe train - Word “train” is sign for the object itself - Egocentric - Rigidity of thought and literal meanings, Amelia Bedelia - Cannot consider which container holds more because cannot think about height and width simultaneously - Putting on a ghost costume must make you a ghost so it is very scary - “Idiot savant” - Some are well developed, others not at all - 14,000 words known by age 7 Psychosocial Development - Preschool Freud = Phallic Stage = heightened interest in sexuality - Preoccupation with genitals, self-stimulation, curiosity about bodies, functions of genitals - Oedipal complex metaphor for identification with same-sex parent and superego conscience emerges for internal self-control - Good time for parents to teach some sex ed safety - Preschool Erikson = Initiative vs. Guilt = widened social spheres, awareness of own autonomy and others’ = initiative needed to learn new tasks - More impulse control, creating working model for later relationships and ability to receive social support - Preschool Mahler = 4th Subphase = consolidation of individuality, beginnings of emotional object constancy - Preschool Kohlberg: - Preconventional Stage 1 = obedience and punishment, based on consequences - Preconventional Stage 2 = hedonistic vs instrumental, based on own needs/perspective - Conventional Stage 3 = “good kid”, based on desire to please others Promotes PreK Development Inhibits PreK Development - Emotionally-available parent - Emotionally unavailable parent - Adequate resources - Insufficient resources - Good parenting skills - Lack parenting skills  - Goodness of fit/parent reaction - Preschooler lacks initiative, lacks to prek development self-control, responds negatively - Preschooler’s initiative, to parent, or has anxiety self-control, and attachment - Peer rejection positive response to parents - Poor quality childcare - High-quality childcare Lawson, et al. (2018) A meta-analysis of the relationship between socioeconomic status and executive function performance among children - Small, significant correlation between socioeconomic status and executive function (EF) performance across all studies Yogman, et al. (2018) The power of play: A pediatric role in enhancing development in young children - Play benefits: - Manage toxic stress - Optimal brain structure/function, executive functioning, language, self-regulation - Fosters positive relationships with caregivers - Without play or safe relationships: - Toxic stress disrupts EF, learning prosocial behavior - Play even more important to regulate stress response - Caregivers need to emphasize play’s importance Sperry, et al. (2019) Reexamining the Verbal Environments of Children From Different Socioeconomic Backgrounds - Past study: By preschool, great discrepancies in vocabularies depending on environment: 5,000 words in lower SES vs 30 million words in higher SES environments - This study did not find the same word gap. Some poor and working-class communities show an advantage in words children heard compared to middle-class communities. Variation within communities also exists, and is more so the take away.  Module 9: School Age Development Lecture: School Age Physical Development - School Age Growth = stable at 5 cm/year and 2-4 kg/year until puberty - Compare to make sure on growth chart curve yet during school age - School Age Gross Motor - Better running, balance, coordination - Active play - SPORTS play large role - School Age Fine Motor - Better hand-eye - Musical instruments - Projects and crafts: build and create things - More specific skills, preferred activities, talents emerge School Age Cognitive Changes - School Age Piaget = Concrete Operations - Mental manipulations - Shift from action to thought with objects - No concepts or abstracts - Chapter books with fewer pictures - Times, Dates, Learn a lot on bus (not always factual) - More logic: cause and effect, less egocentric, takes other POV - Santa and magical thinking disappear in school age - Greater memory, comparable to adults - Object conservation - Complex classification via size, shape, color, etc. - Seriation - Class inclusion - De-centering subjective vs. objective - Reversibility and math operations - School Age Bandura = learn by observing others for resulting in positive outcomes - Does anyone smoke at home? - Parental praise for good behavior - Gives them their perception of their own competence & intrinsic self-motivation = better to over-exaggerate School Age Language - Express feelings, so less need to act out - Alter language to circumstance or person  - Emotional intelligence and respond to social cues - More complex grammar - School age play with language = puns, jokes - Start second language in middle school School Age Social & Emotional - School Age Freud = Latency stage, Superego emerges, impulse control, internalized values & expectations - School Age Erikson = Industry vs. Inferiority - I am what I learn, peer group importance emerges - Focus on what others think about them School Age Identity - Gender differences clearer, and highly determined by norms of environment - May start to note their own gender, non-binary, trans, etc. - If supported in their trans identity by parents, less anxiety School Age Family - Attachment bonds lengthen to immerse in: - Micro (friends) - Meso (teachers, parents) - Exo (scouts, teams, neighborhood) - Macro (social media, laws, religion) - Less immediate reliance on parents for coping, problem solving - Parents still: - model behaviors, values (Bandura) - Protect from enviro - Reinforce school age self worth and efficacy - Provide structure, cohesion, expectations, (weeknight dinner routines) - Sex Ed integration since daily routines and infancy - Be askable parent - Balance family time, quiet time, activities - Teach accountability, discipline, chores - Parents move from role model to coaching role for peer interactions - Siblings: - Only child = high expectations, not displaced - High achiever - Leadership - Less anxious - 1st-born = exclusive attention later displaced - Support status quo  - Achievement-oriented - More anxious - Less self-confidence - 2nd-born+ = more relaxed, less harshly disciplined - Parents and older sibs help social learning - No associations w birth order and IQ School Age Education - 5-6 hours a day for 180 days out of the year - Helps to organize thoughts, acquire abstract - Learn to read, then read to learn - Technology integration - Sustained attention - Teachers are influential, self-fulfilling prophecy School Age Play - Cooperative play - Rules and strategies - Helps form friendships, peer group status hierarchies - Friends based on similarities School Age Bullying - Highest prevalence in middle school - 70% have seen it, 25% experienced it, 30% did it - When bystanders intervene, stops within 10 seconds half the time - Preventing bullying involves: - Active adults - Help kids get help - Open communication - Encourage kids to do what they love - Model how to treat others - Bystander intervention School Age Kohlberg Morals = Conventional Morality - Stage 3 = Good Kid Morality = does it please others? - Stage 4 = Authority Morality = law and order, norms, social rules - Kohlberg thinks many adults arrest at Stage 4 Authority Morality - Altruism = James Fowler prosocial behavior - 3-11 = recognize others’ needs - 6-17 = prosocial supported by stereotypical good and bad, how others view it - 10-17 = empathy, pride/guilt about consequences of own actions - Aggression in schoolage decreases ages 6-7 - 7-10 Aggression  - More verbal aggression - Aggressive kids are rejected by peers, do worse in school - Parental monitoring to curb it Pomerantz, et al. (2014) Raising happy children who succeed in school: Lessons from China and the United States - Chinese children do better academically than American children - Chinese parents more control exerted and involved in their kids’ learning: assisting in homework, providing additional materials, asking about school, and going beyond the assignment - More directive in teaching, focused on correctness of work, and less praise of work, emphasize failures - American parents are less involved in kids’ learning, more focused on children’s autonomy, minimize failures by pointing out what went well - Integration recommended: providing the additional materials, facilitate children’s feelings of autonomy and worth for emotional function as well Stiglic, et al. (2019) Effects of screentime on the health and well-being of children and adolescents: A systematic review of reviews - Evidence that higher levels of screentime associated with adiposity, unhealthy diet, depressive symptoms, and quality of life - Not a lot of evidence on what is a safe amount of screentime exposure Tsao, et al. (2021) Sounding the Alarm on Sleep: A Negative Association Between Inadequate Sleep and Flourishing - Inadequate sleep associated with decreased flourishing - Inadequate sleep for 6-12 year olds = Fewer than 9 hours - 36.4% 6-12 year olds had inadequate sleep - Less interest/curiosity in learning - Apathetic about school performance - Less homework completed - Not finishing tasks - Inadequate sleep for 13-17 year olds = Fewer than 8 hours - 31.9% 13-17 year olds had inadequate sleep - Less homework completed  - Trouble staying calm/in control when challenged - Lack interest/curiosity in learning - Not finishing tasks Module 10: Adolescent Development & Families Raising Adolescents Lecture: - Adolescence = starts physiologically, but ends psychologically - Transition from child to adult - AAP = 11-21 years old - CDC = 9th-12th grade - Gonadal and secondary sex characteristics develop rapidly during puberty - 5 Tanner’s stages - A lot of variation on onset and timing of spurts of development - Can be affected by health, nutrition, geography, background Stages of Adolescence - Early Adolescence = 12-14/15 year olds - Puberty - Body image reassessment - Concrete operational becomes abstract reasoning - Same-sex peer interest - Start to emotionally separate from parent/experiment - Middle Adolescence = 15-17 year olds - More abstract thinking - Personal fable prominent - Strong peer identification - Increased experimentation, health risks - Increased romantic/sexual interest - Emotional separation from parents - Individuation balance bw autonomy and intimacy - Becomes lifelong process - Peter Blos Second Separation - Renegotiate family ties - Try to avoid extremes during process: neither fusion/enmeshment nor alienation - Do not give up on kids - Late Adolescence = 17-22 year olds - Personal identity development - More abstract - Intimate more mutual relationships  - More realistic planning for vocations, education, financial independence - Based on parents, role models, and peers Identity - Erikson Adolescence = Identity vs. Role Confusion - Who am I? Precedes intimacy - Rebellion = a developmental purpose - Try out many roles and quit them = time out moratorium, don’t have to commit - Hatching period = step out of child ID to form new adult ID - James Marcia’s Identity Statuses - 1. Identity Diffusions = put off decisions, feel inadequate, may be loners, not committed to an ID, no experience crisis yet - 2. Foreclosures = early age, know what they want to do in life, family expectations, more anxious & less satisfied, committed - 3. Moratoriums = acute crisis/exploration, try alternatives, not committed - 4. Identity achievements = past the crisis, resolved on own terms, personal commitment to occupation/values/relationships - Cultural ID - Strong culture = grounding, aids adjustment - Biculturalism = greater variety of choices for ID - Racial/Ethnic = Gives stability and resilience Peer Influences & Adolescence - Filters, reference point, social support and stressor - How do peer groups evolve in adolescence? - 1. Same-sex and larger groups - 2. Mixed-sex and larger groups - 3. Smaller groups of couples - 4. Couples and close friends - Peer status groups based on commonalities: interests, popularity Schools & Adolescence - Schools account for major transitions of adolescence: - Middle school - Freshman years HS & college - Living away from home - Variance in school settings: safety, quality, mentoring relationships, expectations, competition, pressurized, athletics vs academics - Better schools have higher parental enviro–HS generally have less - More teen-friendly schools: - Smaller settings/groups within larger schools = best - Connections w teachers/coaches/peers - Clearly stated expectations  - 8:30 am start times or later so 8-9 hours of sleep Adolescence & Sex - Sexual Behavior - Can start healthy sex life - Half have had 1st sexual experience by 17 yo - 20% by 15, 66% by 18 - Affected by: - Parental relationships - family/neighborhood patterns - Other available activities, role models, religion, expectations, communication, support - Abuse, trafficking - Substance use - Educate on healthy and non-coercive - Address inconsistent birth control usage patterns, Plan B options - STIs - Forced experiences - Sexual Orientation - New body and fxns - Maturity at 12-13, has been earlier over last decades - Nutrition, obesity, endocrine-disruptors may all contribute - Need sex ed especially by this age, but start in infancy as it comes up - Comfortably with evolving sexuality - Hard for most to talk about safe sex before starting it = leads to them being unprepared - Access to mental health and supportive care for LGBTQIA who may struggle in their communities for support/understanding - May wait to leave home to disclose - Can be isolating Cognitive Development - Piaget = Formal Operations during adolescence - Think about thinking - Hypotheticals and devil’s advocate - Consider many POVs - More complex reasoning - Parents fall from pedestals, seen more as human - Hot and cold decision making: emotional vs calm and rational, especially in high stress contexts - May perform better academically than social-cognitively  - Elkind Adolescent Egocentrism = Thinking about thinking - Personal Fable = uniquity, needs to temper w life experience, assoc w risky behavior - Need for privacy - Imaginary audience = constantly feel watched/judged - Pseudostupidity = incorrect conclusions/ineffective actions; practice decision-making to not overthink small things - Adolescence Kohlberg = Stage 3 Good Kid & Stage 4 Law & Order - Stage 3 = Good Kid = does it please others? - Stage 4 = Law & Order = norms/duty/laws - Believed many adults arrest here in their moral development Adolescence Clinical Assessment - Home - Education or Employment - Eating - Activities - Drugs - Sexuality - SI - Safety Pasco, et al. (2021) A Systematic Review of Neighborhood Ethnic–Racial Compositions on Cultural Developmental Processes and Experiences in Adolescence - Higher neighborhood diversity insulates kids from racism/discrimination stressors - Higher Ethnic-Racial Identities (ERI) support safer development of kids - Providers can identify areas for kids to explore, support, form own ERI and cultural mentorship - Peer discrimination is more of a concern Branje, et al. (2018) Development of parent–adolescent relationships: Conflict interactions as a mechanism of change - Parent:adolescent dyad important from the get-go to foster better overall relationship quality, parental support, emotional variability - Avoid rigidity - Maintain communication lines - Earlier interventions = Mother Baby and Circle of Security programs Kendall-Taylor, et al. (2021) Framing Strategies to Shape Parent and Adolescent Understandings of Development - NOT mentioning adolescence as a bad/dangerous time, even if to debunk it, because it can further engrain this sentiment just by bringing it up - ONLY: - Exciting time - Young people explore the world, discover who they are - Parents NOT “pushed away” - ONLY: - You remain important - They watch what you do and seek your advice - It is their job to become increasingly independent - NOT “all engines no breaks” - ONLY: - They are “super learners” - Our job is to give them safe opportunities to expand their knowledge and skills - NOT “peer pressure can be painful and harmful” - ONLY: - Need to learn how to have important relationships outside the family - Important to support them to have these healthy relationships - NOT your child needs professional help and I am very worried we need to act quickly: - ONLY: - Your child deserves to feel better - This is an opportunity to develop their skills to help them manage uncomfortable feelings Module 11: Individual and Family Risks, Strengths, and Resiliency Lecture: ACE Studies, 1998: - 20 years, 18k middle income adults - Strong, graded relationship bw level of ACEs and: - Health - DM - Depression, SI - STDs  - Heart disease - Ca - Stroke - COPD - Broken bones - Obesity - Effects on genes in hippocampus in re:stress without buffering = epigenetics early damage to CNS - MH - Behavioral outcomes - Smoking - EtOH - Drugs - Graduation & academics - Lost time from work ACEs types: - Abuse (physical, emotional, sexual) = more physical abuse seen - Neglect (physical, emotional) = more emotional neglect seen - Household dysfxn (mental illness, incarceration, mother treated violently, substance abuse, divorce) = more substance abuse seen - MH esp if primary caregiver affected - Divorce not always an ACE ACEs long-term impact on mothers/parents & attachment: - Chronically under threat = cannot recognize and respond to kids as they need - Disabled caregiving - Too activated, lost in own bodies - Fail to protect - They act in ways both frightening and neglectful ACEs screening/tx - cost/benefit - Need more work into evidence-based interventions of ACEs Types of Stress & Effects - Positive Stress = normal part of healthy development - Inc HR - Inc Hormones  - Causes include 1st day of school, immunizations - Tolerable Stress = increased stress, but buffered by supportive caregivers - Activation of body’s alert system - Death of a loved one, natural disaster, frightening injury - Toxic Stress = strong, frequent, or prolonged adversity in the absence of supportive, responsive caregiving - Damages brain’s architecture and organ systems - Chronic neglect, emotional or physical abuse, exposure to violence, poverty Protective Factors, Buffers, & Resilience - Protective Factors = shelter or buffer individuals from negative interactions/behaviors/adverse outcomes - Examples of Protective Factors = individual personal resources, microsystem intimate partner support, exosystem public programs, macrosystem Welfare to Work policies - Resilience = ability to adapt successfully to acute stress/trauma/more chronic adversity - Families face both normative (developmental, transitions, relocations) and non-normative (catastrophes) stressors - Resilient families respond to both by protecting themselves from breakdown, fostering adaptation - May become overwhelmed if too many stressors in community Patterns of Resilience - Dispositional Patterns = intelligence, pleasing physical appearance, easy temperament, self confidence, self esteem, mastery - Relational Patterns = ID/relate to mentor, seek out friends, good social skills, humor, willing to seek out/use community support - Situational Patterns = realistic appraising, flexibility, perseverance, creativity, use of active problem-solving - Philosophical Patterns = hopefulness, faith/finding positive meanings, belief that life has purpose BCEs - Benevolent Childhood Experiences (BCEs) associated with less current PTSD, less stressful life events, despite ACE levels - BCEs include: - Safety w caregivers, good friends, teachers, neighbors  - Predictable home routines Resilient Parenting: Infants & Young Kids - Secure attachment - Parental warmth/comfort after stress - Emotionally available - Model competence - Appropriate expectations - Rules, structure, authoritative styles - Parental education/intellect - Required helpfulness Family Risk Factors for Kids’ Wellbeing Total quantity of all of these may be more predictive than any one on its own - Ongoing parental conflict/violence - Parental depression/MH issues = esp mother dep - Attachment affected - Childhood depression - Lack physical care - Parentified kids - Stigma - Parental separation/divorce - Harsh parenting/physical punishment - Child abuse, neglect, violence - Foster care - Parental death or major chronic illness - Substance abuse - Worse if mother compared to father - Poverty, food insecurity Risks in Adolescents - CNS circuitry, esp AMAB - Personal fable - Less time with family, more time w peers - Identity process and moratorium - Limited life experience - Behaviors: substances, alcohol, diet, sedentary, peer groups, gangs, toxic enviros, unsafe spaces, unsafe sex  - Social disorganization theory - 50% adolescence morbidity from 4 behaviors: - Sexual activity - Substances - Recreational or MVA - Interpersonal violence - 80% deaths 15-19 yo = injuries - MVA = 50% - Homicide = 35% - Leading COD young Black AMAB - Suicide = 15% - AMAB 2x mortality Family Protecting Adolescents Risks to Adolescents Protecting - Access to guns/substances at - Involved and connected home - Family meals - Working >20 hours/week - School connectedness - Expectations of academics - Appearing older than most in - Disapproval of early sexual class debut - Repeating grade, academic issues - Less family involvement Programs to Support Resilience - Competence, connection, character, confidence-building - Schools as community centers - Support parenting/home visits to parents - Peer programs = teen volunteering activities - Coping skills trainings - Arts, sports, outward bound activities - Screen and prevent toxic stress starting in pregnancy - 2018 AAP Resilience Project toolkits/resources to prevent and address trauma and stress in kids’ lives Transgender Youth Child Development - Higher rates: anxiety, dep, SI, substance use - Inc rates discrimination and harassment compared to other LGBQIA kids  - Lack of training in patient care for providers Rafferty, et al. (2018) Ensuring Comprehensive Care and Support for Transgender and Gender-Diverse Children and Adolescents - TGD = Transgender & Gender Diverse - Need more formal training, standardized treatment, research on safety and medical outcomes - Population surveys rarely ask about TGD - No large-scale prevalence studies done in youth - Previous studies shown avg 8.5 years old when first felt gender difference, even if don’t disclose until avg 10 years later - Risk for depression, anxiety, eating disorders, self-harm, suicide - Internal conflicts about appearance and ID - Limited MH support - Limited providers with expertise - Lack of civil rights protections - Risk for homelessness, physical violence at home/in community, substance use - GACM = Gender-Affirmative Care Model - Not a mental disorder - Variations of gender identity and expression are normal aspects of human diversity - Gender identity comes from biology, development, socialization, culture - If mental health exists in TGD population, usually from stigma or negative experiences not intrinsic to the child - TGD Healthcare Issues: - Safety: safe environments, fear of discrimination - Poor access: STI testing included, insurance denials - Mental Health access - Lack of provider continuity - Gender affirmation among adolescents allows them to then focus on other important aspects of their development: academics, relationships, future-oriented planning - Social Affirmation: - Reversible - Hairstyle, clothes, pronouns, name - Legal Affirmation: - Reversible  - Official name/pronouns on legal documents - Varies state by state, may require specific documentation from pediatric providers - Medical Affirmation: - Reversible/not - Hormones to develop secondary sex characteristics - Surgical Affirmation: - Hair distribution, chest, genitalia, internal organs - Irreversible - Usually reserved for adults - Parental support is vital: at least 1 supportive person = significantly less distress and better mental health outcomes Hastings, et al. (2021) Medical Care for Nonbinary Youth: Individualized Gender Care Beyond a Binary Framework - NB have been somewhat ignored in favor of trans care in healthcare settings - Affirming language, focus on individual embodiment goals - Pubertal suppression, hormones, surgeries - Not “masculinizing” or “feminizing”--JUST DESCRIBE WHAT THE PHYSICAL EFFECTS ARE Taliaferro, et al. (2019) Social Connectedness Factors that Facilitate Use of Healthcare Services: Comparison of Transgender and Gender Nonconforming and Cisgender Adolescents - TGNC Youth: - Parent connectedness plays a critical role in accessing primary and dental care - Mental health care reliance stems from lack of broader adult support and systemic issues, like housing insecurity - Cisgender Youth: - Friend networks impact dental care access - Lower parent connectedness increases MH reliance - Systemic Barriers: - Housing and food insecurity limit access for all - Urban TGNC youth fare better than rural counterparts for accessing care